Previous research and practice indicates despite implementation of Safe Patient Handling polices and training, patient lifting devices are not consistently used. Barriers and promoters for use of these devices include worker, patient, environment, and organizational factors. Determining the factors that are present and to what degree they influence patient lift equipment use or nonuse decisions will address and develop better strategies to increase appropriate use and adoption of these devices and inform and support future policies and training. The primary study aim is to explore the magnitude and importance of factors influencing use or nonuse of patient lift equipment using a case crossover study design. Potential factors identified from the literature and a previous lift equipment evaluation study will be integrated with field observations and interviews conducted with hospital staff to create an assessment tool to capture the frequency of these factors for patient lifts and transfers. A novel case crossover study will quantify the frequency and association between identified factors and lift equipment use among 100 nursing staff engaged in patient care in the acute care hospital setting. Participants will prospectively document patient lifts and transfers, use of lift equipment, and the presence of factors during their shift. Determining factors associated with lift equipment use for patient lifts and transfers that are most amenable to intervention is significant and will inform future practices and strategies to overcoming these barriers. This study provides an interesting exploration of the case crossover design, traditionally used to study triggers for injury, to more clearly understand how decisions about exposure are made. This proposal addresses NIOSH Healthcare Sector goals of increasing the understanding of adoption of proven interventions and decreasing musculoskeletal disorders. Understanding factors that determine use of lift equipment fulfills r2p initiatives by providing specific information that can be put into practice by hospitals and safety specialists to increase appropriate use of these devices. Developing a novel approach to study the use and acceptability of engineering controls could serve as a model with more general applicability to other health and safety issues faced by workers in health care and other occupational settings.